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Cost-effectiveness of using prothrombin complex concentrate to prevent complications related to overdoses of anticoagulants in the emergency department

Quintana Díaz M, Borobia AM, Pérez Cachafeiro S, Rodríguez C, García Erce JA

Servicio de Urgencias, Hospital Universitario La Paz de Madrid, Spain. I+D+i, Complejo Hospitalario de Pontevedra, Spain. Grupo de Investigación USEES-URG, Spain. Servicio de Hematología, Hospital San Jorge de Huesca, Spain.

Background and objective: Prothrombin complex concentrates (PCCs) are currently
used principally for rapid reduction of the anticoagulant effects of administering
vitamin K in cases where acute bleeding develops or during emergency surgery. PCCs
are a better choice than fresh frozen plasma in these situations. These drugs have
become essential for reducing the risk of hemorrhage thanks to their composition,
safety, and rapid restoration of hemostasis, specifically of the international normalized
ratio (INR). This study aimed to assess the efficacy, in terms of incremental costeffectiveness,
of PCC use in restoring the INR in routine emergency department
Study design: For the cost-effectiveness analysis we constructed a year-by-year decisiontree
(Markov model) using spreadsheet software (Excel). The probabilistic simulation
sampled 5% of all emergency department patients on oral anticoagulant therapy with
antivitamin K and an elevated INR in each year for 10 years. Octaplex® was the PCC
used in the model.
Results: Sensitivity analysis showed that PCC use had a more favorable incremental costeffectiveness
ratio than did other strategies for correcting the INR.
Conclusions: Use of PCCs in the emergency department would be cost-effective.

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